ADHDnews i41 - the Voice of ADDiSS - The National ADHD Information and Support Service by Roh Nos

issue Spring 2018

Reproduced courtesy of Micahel Vella

The voice of ADDISS - The National ADHD Information and Support Service

Exploring THIS ISSUE

ADHD & ART

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Help change the face of 5-8 ART and 4 ADHD RESEARCH: ADHD EUROPE PSYCHIATRY the MOODCYCLES STUDY at the SGDP Conference and AGM A report from the

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ADHD Europe Conference and AGM ADHD Europe Annual Conference and AGM 23rd February 2018, Cavileiri Hotel, St Julian’s Bay, Malta

By Francesca Wadding�on

he Annual ADHD Europe Conference was held in beautifully sunny Malta. Although our conference room had stunning views of St Julian’s Bay and the Mediterranean Sea, to rival that we had four speakers that captivated our attention. Professor Susan Young, a Forensic Clinical Psychologist and CEO of Psychology Services Limited, gave a presentation on “The Consequences of untreated ADHD.” She talked about how if ADHD is left untreated, it can have devastating effects on individuals’ lives. Untreated ADHD can unnecessarily lead to the “classroom to courtroom problem”, whereby individuals with ADHD perform poorly at school and, if behavioural problems are not tackled appropriately throughout development, they are more likely to get involved in crime. This problem continues into adulthood. Professor Young also demonstrated the difference in outcomes between treated versus untreated ADHD. Driving abilities and academic achievement were significantly higher for people who were treating their ADHD compared to people who were not treating their ADHD. However, research suggests that there is not much difference in respect to occupational outcomes between those who treat or do not treat their ADHD. This implies that more interventions are needed to improve occupational outcomes for individuals with ADHD. Professor Philip Asherson of King’s College, London talked to us about “The Wandering Mind.” Mind

wandering is a concept that researchers define as the period of time when your attention and thoughts drift away from the task that you are completing, to your internal thoughts and feelings. This can be intentional, e.g. you start to think about a party that you are planning, or unintentional e.g. you should be focusing on a lesson being taught, but you find yourself thinking of anything but the lesson. Sometimes these mind wandering thoughts can interfere with how you carry out tasks you are supposed to be completing. Professor Asherson told us that mind wandering, particularly the unintentional type, appears to be a common feature of ADHD. Researchers in Professor Asherson’s group have been developing a scale to measure mind wandering and are continuing to investigate the phenomenon of mind wandering and its relationship with ADHD. Professor Philip Asherson also informed us of a project he has been working on with Dr Kai Syng Tan, an artist with ADHD. Together they have created artwork that celebrates mind-wandering and neurodiversity, with the intention of connecting the public with research in order to explore and reflect on the relationship between art and science, clinician and patient and our definitions of normal and abnormal behaviour. Professor Dr Sandra Kooij is a Psychiatrist at PsyQ in The Hague. She educated us on “ADHD, Circadian Rhythm, Sleep and Health.” Research has shown that the sleep cycle is linked to ADHD. Poor sleep leads to poor cognitive functioning. Individuals with ADHD are prone to these problems, which may exacerbate

- Spring 2018

One of the artists keen to display their work was Doris Pace. She got into art through her children. Doris often found herself supporting her children’s art projects and soon became inspired during the outings with her daughter to paint the sunset. Since then Doris has produced a range of pieces in different styles from landscapes to abstract artwork. Although Doris mainly works with acrylic and likes to create texture in her artwork using everyday objects such as combs and her paint tubes, she also experiments with resin and even nail varnish! However, Doris is self-taught and continues to learn new techniques using videos on the internet as a guide. Doris has now developed enough of a collection to hold her own local exhibition. Together with her son, who is a photographer and has ASD, they held a successful exhibition with the proceeds being donated to a local Learning Disabilities charity.

Reproducerd courtesy of Doris Pace

Doris also paints for therapy. She feels that painting is beneficial for expressing issues that she is experiencing. This outlet for expression helps her to understand and deal with any difficulties she faces and she encourages others to explore self-expression through art. In the future, Doris would like to continue exploring different styles and aspires to run her own art therapy group.

ADHD and Art in Malta To open the ADHD Europe annual conference and AGM, a wonderful art exhibition evening was held at the Cavileiri Hotel in St. Julian’s Bay in Malta. However, this was no ordinary art exhibition. by Francesca Wadding�on

DHD Malta, an active organisation within ADHD Europe, organised an exhibit of work by artists with ADHD and links to the ADHD community in Malta. As you may know, creativity can be a positive aspect of ADHD, so it was a wonderful opportunity to celebrate such talent in the ADHD community. The range of artwork on display, by artists of all ages, was inspirational.

ADHD symptoms. Prof. Dr Kooij also showed us research that points to a link between light intensity and ADHD. Consequently, Prof Dr Kooij questioned whether ADHD could actually be a Circadian Rhythm Disorder. Finally, Jerry Mills, an inspirational speaker and former teacher with personal experience of ADHD, talked and sang about “The Heart of the Matter”. This described the experience

Daniela Guevska was another artist displaying her landscapes at the art exhibition. Daniela is a professional artist, with a background in woodcraft and graphic design. She moved to Malta from Bulgaria and decided to paint landscapes to learn about the Maltese culture, as a way of connecting with others in her new environment and to help her overcome her fear of the sea. She also advocates art as a tool of self-expression and encourages others to express themselves too. Daniela is dyslexic and has run workshops for teenagers with dyslexia and ADHD as well as working as a community artist with disadvantaged groups, such as disadvantaged children, domestic abuse victims and immigrants. Daniela is currently working with ADHD Malta to find their next venue for more workshops with young people with ADHD.

of having ADHD, the relationship that the education system and its teachers have with children with ADHD and the powerful impact this can have on a child’s life. Jerry highlighted the need for a positive change in attitude towards children with ADHD in the education system, as this can have positive life outcomes for these children. This was a very emotional session, but a wonderful way to close the ADHD Europe Conference.

DORIS PACE

The ADHD Europe AGM was also held during the same weekend in Malta. ADHD Europe elected new Board Members, a Treasurer and 2 Vice-Presidents to its Board. ADHD Europe welcome: Myriam Bea and Marko Ferek as the VicePresidents, Chantal Fouche as Treasurer and Hans van de Velde, Carola Stivala and Isabel Rubio as Board Members.

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This Moodcycles study aims to identify the links between genetic variations, the severity of cognitive dysfunction, emotional instability, dopamine levels and low estradiol (estrogen) levels during the second part of the menstrual cycle in ADHD women. Increasing the understanding of this complex monthly interplay will assist in the development of effective personalized mental health treatment for ADHD women. Over a 2-month period, women with and without an ADHD diagnosis will answer a few questions daily about her mood and cognitive functioning (via a simple app). In addition to the emotional and cognitive self-reporting, each woman will be measured twice during one cycle using the following range of research tools: • brain scans (fMRI) of the prefrontal cortex while performing a cognitive task • a cognitive test (Qb test) • blood hormone levels

Help change the face of ADHD research: The Moodcycles Study Last month was International Women’s Day. We saw women around the world challenging the defining role of women in their cultures and demonstrating for their right to be heard, educated and their basic needs acknowledged. One challenge that we still face is understanding fully how ADHD affects women.

DHD is historically thought to be more prevalent in males and medications are predominantly tested on men. Due to standardized research and testing practices in medical science, women have historically been excluded due to effects of periodically fluctuating hormone levels on the functions of the female body. Consequently, we know a lot about ADHD and the effects of medication in men, but hardly anything is known about women and ADHD medication! It is already known that women can experience mood swings during their cycle. Women with ADHD report that not only is their general mood worse, also the severity of their inattention, low impulse control, quality of sleep and other ADHD symptoms increase. Some women also report that the efficacy of their ADHD medication is greatly reduced when premenstrual. Post menstruation, these

symptoms diminish, but recur as the next menstruation approaches. This can have a significant impact on women’s lives, affecting every aspect of their life and relationships. It is important for us all to understand why these mood cycles are more severe in ADHD in order to develop better recognition and treatment. Despite the clear and urgent need for more research into female ADHD funding for research and treatment development is scarce. Prof Dr Sandra Kooij of PsyQ is working hard to change this using ADHDFund - a patient-driven website to crowdfund ADHD research- to fund the Moodcycles Study. “Around 5 in every 100 women is affected. That is not small, but a critical problem! If we don’t want the priorities of women with ADHD to be overlooked then we have to take control by working together to fund the research ourselves!” www.adhdfund.com

To investigate the link between the individual traits (endophenotype) and genetic markers (genotype), the genetic profile of each woman will be recorded. The total costs of this study are estimated around 500.000 euro, to pay for the assessments, laboratory tests, brain scans and researchers involved. The outcomes will be published both in scientific journals as well as online, for open access by people with ADHD. This will be the most detailed study ever conducted of how female hormones interact with ADHD to affect mental health and you can be a part of it! Get involved!

What can I do? Please visit: www.adhdfund.com/en/campaigns/ moodcycles-collect-data Here you can read more about the study and do the following: 1. Donate to the MoodCycles study now, and spread the word among your ADHD friends through social media! Only together we will achieve the funding goal! 2. Participate, by filling in the questionnaire on Mood Changes in ADHD through the lifespan: in the premenstrual, postnatal and perimenopausal periods Together, we can do this!

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Can we see Mind Wandering?

reproduced courtesy of Kai Syng Tan

A specific network in the brain called the default mode network (DMN) is said to have something to do with the causes of SMW. The DMN activates when we are not doing anything (for example when resting), and deactivates when we perform a task that requires attention. Functional magnetic resonance imaging (fMRI) has been used to measure activity in the DMN. In one fMRI study, 35 adults diagnosed with ADHD as children (13 of whom who still had ADHD as an adult and the rest in remission), had their brain scanned.

An event entitled “Mind Wandering: Worst Enemy or Best Friend?” took place in October last year at the Social, Genetic & Developmental Psychiatry (SGDP), Institute of Psychiatry, Psychology and Neuroscience, King’s College London.

he intention of the evening was to open up and challenge our understanding of how the mind works, with particular attention paid to ADHD and, more generally, the boundaries between wellness and illness and how the arts can contribute to and complicate this discourse. The programme was a part of artist Dr Kai Syng Tan’s #MagicCarpet, a 1.5 year art practice-related interdisciplinary collaboration by the SGDP’s Artist in Residence and you can read Kai’s review of the event and find links to her work at: [www.a-n.co.uk/blogs/mind-wandering-bestfriend-or-worst-enemy] Dr Jane Sedgwick attended the event and was inspired to write the following account of the association between mind wandering and ADHD, drawing on art practice and psychiatry for examples.

Introduction to Mind Wandering Mind wandering is a super interesting concept because we do it all the time! But I really want to discuss how mind wandering, over a long period of time, has interlocked art practice with psychiatry. First though, it’s important to define mind wandering, because this sets the scene. Mind wandering is a concept that is used to describe thoughts that do not or cannot remain on a single topic, including when we engage in a task that requires attention.

There are 2 types of mind wandering:

DMW

Deliberate or intentional mind wandering

SMW

Spontaneous or unintentional mind wandering .

Spontaneous, unintentional mind wandering is said to be a core deficit in ADHD. This means adults with ADHD often report SMW - uncontrollable thoughts that are constantly on the go, flitting from one idea to another or ceaseless mental activity (Asherson, 2005). It is easy to assume that SMW is “bad” and attention is “good.” It is also easy to assume that DMW is better than SMW, since you can control the former whilst the latter feels like a loss of control. Keep this in mind, and then come back to them once you have finished reading this essay. Other things to keep in mind, are the polarised views that came out of this SGDP event. When art practice traversed psychiatry at this event, it illuminated views about the medical versus social model of ADHD, normality versus abnormality and imagination versus disorder. Within the medical (or scientific) model of ADHD, SMW is an intrinsic physical anomaly - a core deficit in ADHD. We are realising now how important it is in ADHD as a source of impairment, but it is still under-recognised.

The findings revealed that adults who were in remission, or without ADHD displayed distinctive synchrony in two major hubs within the DMN (the medial prefrontal & posterior cingulate cortex) when their minds were at rest. In adults with ADHD this was not the case. Synchrony in these major two hubs was not found when their minds were at rest (Mattfeld et al, 2014). The findings of this study clearly suggested that in adults with ADHD, the two major hubs in the DMN fail to synchronize. This could explain why people with ADHD report not noticing that their minds had wandered during given tasks, or that they only notice it a while later. This absence of this ‘meta-awareness’, which is a component of metacognition (to have an awareness and understanding of one’s own thought processes), could have deleterious consequences, for example when operating certain kinds of machinery (Smallwood, 2013). When it is not disrupted, meta-awareness is said to correct mind wandering, by suppressing the flow of spontaneous thoughts and making us more attentive (Flavell, 1979).

Socio-politico aspects of ADHD – what is normal anyway? Within the medical model, ADHD is a disability that impairs an individual’s social functioning, reducing their quality of life and putting them at a disadvantage. The aim is to cure or manage the disability so that social functioning is restored and a good quality of life becomes achievable. Doctors help people affected but they focus on impairment, and not the sociopolitico aspects associated with disability. Genetic or biological variations in people’s physical, sensory, intellectual or psychological make-up surely can impair social functioning, but these differences only become disabling when society fails to take them into account. The socio-politico aspects of disability illuminate social factors that cause exclusion. In 1983, Mark Oliver coined the term: “social model of disability” (SMD), to underscore systemic barriers, negative attitudes, stigma and discrimination as social factors that disable people. Within the SMD, “disability” is a social construct used to differentiate people

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according their diagnostic labels, such as ADHD. These labels are said to separate people from mainstream society, because they deviate from dominant views of normality. Since difference or “abnormality” is not valued by the mainstream, disabled people experience social exclusion (Oliver 1983, 1990). The SMD challenges social exclusion and marginalisation, so that disabled people can claim their rightful places in society (Oliver 2009). A philosophy of difference is embedded within the SMD. This means that even though all disabled people, including those with ADHD, have equal rights under the Equality Act 2010, their lived experiences are still different. Indeed, some people with ADHD experience severe symptoms and functional impairments, while others experience the same level of symptoms but can be high functioning. It also means that we need to consider subclinical presentations of ADHD and how they impact on an individual’s social functioning. By doing this, a much better understanding of the biopsychosocial dimensions of ADHD, including SMW, could emerge (Smallwood and Andrews-Hanna, 2013). Another point to make is that within the SMD, mind wandering is only considered a disability if it’s label as a “core deficit” or “impairment” causes people with ADHD to become socially marginalised and disadvantaged (e.g. they get excluded from certain occupations).

Mind wandering through history – automatism and spirit writing Dominant views about normality versus abnormality, or ability versus disability, can influence society’s understanding of “private mental experiences.” This is particularly true for mind wandering, which we seem to have been fascinated with since the classical era. Plato once portrayed Socrates as “capable of standing all day in the market place lost in thought and oblivious of the external world” (Singer 1966). In 1842, a physiologist called William Carpenter, claimed to have discovered unconscious cerebration: a kind of sub-volitional thinking. This “discovery” became very popular among intellectuals and literary figures of that time such as Oliver Holmes, Mark Twain and Alexander Bell, who invented the telephone. Bell, in one interview, even said, “I have heard that people dream inventions. That is not at all impossible. I am a believer in unconscious cerebration. The brain is working all the time, though we do not know it. We are thinking all the time – it’s impossible not to think” (cited by Marden 1901, p.33). Unconscious cerebration offered a scientific explanation for bodily movements that occurred without conscious control (e.g. breathing or sleepwalking). This sort of automatism, revealed what Carpenter called “well-worn nerve paths” in the brain, stretching beyond conscious control, perhaps like the DMN. Carpenter also used unconscious cerebration to explain a popular literary practice called

Jane Sedgwick is a Senior Teaching Fellow &

Programme Lead for BSc Mental Health Nursing at the Florence Nigh�ngale Faculty of Nursing, Midwifery & Pallia�ve Care, King’s College London. She is also a PhD Candidate at the MRC Social, Gene�c and Developmental Psychiatry Centre, Ins�tute of Psychiatry, Psychology and Neuroscience, under the supervision of Professor Philip Asherson. Her research project is inves�ga�ng the impact of ADHD on the educa�onal outcomes of university students and the effec�veness of reasonable adjustments in promo�ng posi�ve learning experiences. Jane is also an Execu�ve Commi�ee Member of the UK Adult ADHD Network spirit writing, describing it as process by which a thought (or mental image) brought about a reflexive or automatic muscular reaction. Literary scholars at that time described spirit writing as a psychic gift for channelling information, predictions and spiritual energy. Fernando Pessoa (c. 1888-1935), a prominent literary scholar and one of the greatest poets in the Portuguese language, said he experienced spirit (or automatic) writing. About 30 or more years later, Pierre Janet (c.1859 – 1947), a French philosophy, psychologist and psychotherapist, contested Carpenter’s materialistic view. Janet psychologised automatism in pioneering research about dissociation and traumatic memory. Janet developed a model of the mind that emphasised conflict between synthesis (unity) and automatism (disintegration). The former being a “psychological strength” and the later a “psychological weakness.” Fixed ideas, lack of volition, hypnosis and automatic writing, were symptoms of automatism. In his publications, Janet described how his patients dissociated into fragmented “selves” and how these “multiple personalities” often played out during a state of “artificial somnambulism” (sleepwalking). In Janet’s view, his patients suffered from enfeebled minds; automatic and devoid of creativity (Janet 1892; 1889/1989). Historical accounts of automatism seem to reflect more recent accounts of mind wandering. These accounts also allude to art practice and how, over the years, it traversed psychiatry in ways that appear to have influenced advances in both these fields. In 1919, a student in neuropsychiatry-turned-poet, André Breton (c.1896 –1966), and his friend Philippe Soupault (c.1897–1990), wrote “the first work of literary Surrealism” - Les Champs magnétiques (The Magnetic Fields). Bacopoulos-Viau (2012) said Les Champs was “the product of two wandering minds on paper that represent the first systematic use of automatic writing” (p.259). In 1924, Breton founded Surrealism, with his Manifeste du surréalisme – it’s aim was to resolve “previously contradictory views about dream and reality into an absolute reality, a super-reality.” Breton

said Surrealism was “pure psychic automatism by which one proposes to express – verbally, by means of the written word or in any other manner – the true functioning of thought, absent of any control exercised by reason, aesthetic or moral concern’ (Breton,1924/1972 p.26). Just like mind wandering, the importance of automatism cannot be underestimated. Automatic writing, like mind wandering, blurred boundaries between science versus spiritism, normality versus abnormality, madness versus creativity, and in this way it helped to shape modern imagination. Unlike the contemporaneous narrative method or device - “stream of consciousness,” automatic writing was preoccupied with the unconscious mind (just like psychoanalysis). The genesis of automatism was neither scientific nor artistic, instead it originated from spiritism. As such, we can read and understand Janet’s and Breton’s use of automatic writing as a commentary on fin-de-siècle (turn of the century) positivism, or to be more precise, fin-de-siècle art and science of mind wandering. The notable artists, André Masson (c. 18961987), and Leonora Carrington (c.1917– 2011), both used Surrealist automatism to produce drawings and paintings. Arguable, this technique does make mind wandering visible. But whether Surrealist automatism is an example of DMW rather than SMW, is open to debate. Fox & Christoff (2014) argue that a lot of mind wandering research has focused on disadvantages or costs. Yet many people are known to engage in productive non-maleficent SMW including scientists, mathematicians, philosophers and artists. Fox & Christoff’s view of a positive-facilitative role for metacognition (an awareness and understanding of one’s own thought processes) in mind wandering uses 3 examples: creative thinking, lucid dreaming and mindfulness meditation and could certainly support Surrealist automatism as a firm example of productive SMW. PAGE 8

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y son Justin (not his real name) was diagnosed with ADHD at the age of 5. When his symptoms were better controlled, it became clear that there were other issues as well and he was also diagnosed with ASD and learning difficulties. When he was 19, Justin was placed in residential care with a view to helping him learn more independent living skills. Unfortunately, the residential care environment did not suit him. He found it too regimental and he also had personal conflicts. It was decided that a supported living environment would be more appropriate. However, by then Justin was in a relationship and did not want to move too far away from his girlfriend so a temporary alternative placement was found for him whilst waiting for the right place. It was during this temporary placement that Justin became involved with people that unfortunately took advantage of him both financially and emotionally. He was exposed to a lot of situations that were not good for him and from which he learned the wrong way of dealing with things. After another failed placement Justin finally moved nearer home. He became friendly with the young man who lived in the flat next door. They were both receiving supervision in a supported living environment. Justin’s new friend had his own difficulties and would have ‘fits’ or threaten to cut himself if things were not going his way. From this, Justin learned that this kind of behaviour was powerful and could be very effective at getting a response. Justin was unhappy with his friend keeping two girlfriends in tow. To his ASD mind this was highly deceptive and unfair and, after they had all had a drink, the situation got out of hand and ended with Justin being arrested for accusations of threatening behaviour with a blade. The judge for the case ruled that Justin had to be placed in a residential setting and he was released on bail. After moving into a residential setting, things were OK for a while. However, Justin was disturbed by one of the residents who was much more disabled than Justin and who was making noises all day and night. One night, Justin snapped and when a carer entered the resident’s room Justin squeezed past and thumped the resident. This was, of course, unacceptable behaviour and a new place had to be found within the same organization.

A mother’s account of her ADHD son’s experience with the UK Justice System Upon reaching the new house, Justin realised that the new accommodation was not a residential care facility like the one he had come from but was now a supported living placement. Justin knew the judge had stated that he should be placed in residential care and he felt strongly that this was not right! Soon after arriving Justin protested, remembering the effective use of a knife and threat of self-harm that he had seen previously. The police were called and arrived just as Justin was walking into the front garden still holding the blade. He was arrested. Justin could have been released on bail but sadly his parents were abroad that weekend so no bail address was available. As a result, Justin was taken to Pentonville prison! Everybody involved in the case agreed that this was not the right place for him but at the time, sadly, it was the only option. Justin’s parents returned and tried to locate him but it took three days before he was found, and only after a friendly prison chaplain came to their aid and confirmed that was where he was. During the difficult time that followed waiting to get him out of Pentonville, Justin learned more negative behaviours. Here he learned that flooding your cell can be an effective way of getting attention and listened to the other unhealthy experiences of his cellmates. Justin was moved within the prison to a variety of wings and exposed to the company of several inmates. Visiting was not granted until he had been there one month and to say this was distressing is an understatement!

By the time we could visit him, Justin had been self-harming, digging craters into his arms with his nails, he was also completely unkempt and looked awful. The judge who had originally dealt with Justin’s case was contacted by the solicitor and, eventually, Justin was moved to Lewes prison. Here conditions were better, but the lack of understanding of Justin’s condition was very clear. Once again, everyone involved with Justin’s case was convinced that this was not the right environment for Justin but the wheels turn very slow. Eventually, it was decided that Justin should be assessed in a secure psychiatric unit and he was moved there. After his assessment period, it was agreed that Justin should stay in the secure psychiatric unit for treatment. It was thanks to the judge involved in Justin’s case, who had a good understanding of all of Justin’s issues, that this step was finally taken. Moving on from these events has taken a lot of ‘unlearning’ and rebuilding. Justin is finally receiving treatment which considers all his needs, and psychiatry, psychology as well as occupational are all involved and working together to address a posttraumatic stress disorder which is now also a part of his difficulties.

I have written this piece of Justin’s story to highlight the issues in prison.

• How many more Justin’s are in this

situation, and why can’t there be provisions within mental health to prevent people like Justin ending up where they have? So much more can be done.

• There is still so little understanding within the justice system despite campaigning for better insight

• How many more parents are there

out there who can identify with Justin’s parents?

• What can be done to bring cases like this to the attention of the powers that be?

• So much unnecessary damage has

been done, and the entire development of a young person has been delayed tremendously, now including the experiences, company and environment he has lived through. Hopefully, the more professionals, parents, carers and support groups that are aware and raise awareness of the problems that exist, the more that can be done to limit the terrible damage that can be caused.

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Mind Wandering & ADHD ...from page 6

Mind wandering – a source of great creativity The association of creative thinking with SMW and metacognition aligns with the notion that creativity is a positive aspect of ADHD. Higher scores on the “unusual uses test,” which is a measure of divergent thinking (the ability to come up with creative solutions), was found in young adults with ADHD, when compared to non-ADHD peers (White and Shah, 2006). In a sample of 10,104 university students, the students who had higher levels of ADHD characteristics were found to have more entrepreneurial intentions (Verheul et al, 2015). Gifted students with ADHD were found to have poorer working memory, but they also demonstrated greater creativity when compared to gifted students without ADHD (Fugate et al, 2013). Creativity is hard to define due to its multifaceted nature and numerous expressions, but research has found that people with ADHD have more real-world (or real-time) creative achievements, when compared to people without ADHD (White and Shah, 2011). Spontaneous mind wandering may be a prototypical feature in ADHD, but it also seems to be double-edged gold sword, certainly fitting well with the title of the SGDP event – mind wandering: best friend or worst enemy. Spontaneous-unintentional ideation occurs all through our waking hours and even continues into sleep. These unintentional streams of thought reflect our personal concerns, inner debates, inter-personal feelings, unfulfilled goals, worries, hopes, visual imagery, intrusive memories, daydreams, fantasies, imaginary social interactions, future plans and so on. Mind wandering could be a best friend that brings gifts such as creative thinking, prospection, mental breaks and finding a sense of purpose or meaning for our day-to-day experiences (Baird et al 2010; Mooneyham & Schooler 2013; Seligman et al 2013).

Not all who wander are lost The ability to switch between streams of thought (attentional cycling) enables us to multitask or to simply get relief from boredom. Still, having a busy mind when we are not otherwise occupied can be disruptive, especially when we need to engage in a highly demanding task. Spontaneous mind wandering in adults with ADHD predicts poor performance on a wide range of tasks. It is associated with poor attention, concentration, working memory, and reading disability (poor retention and comprehension of difficult texts), and deleterious consequences such as poor academic achievement, poor work performance,

traffic accidents, negative moods and medical malpractice (Smallwood et al 2008, 2011; Franklin et al 2011;

Galéra et al 2012; Mrazek et al 2012; Mooneyham and Schooler 2013).

Endlessly, we could debate the pros and cons of mind wandering – deliberate or spontaneous, after all, it characterises about 50% of our waking life. Perhaps the main point to make is that people with ADHD often do not notice that their mind has wandered, or only notice it after a while. This absent meta-awareness is a concern, but it also could be a target for intervention. The DMN seems to play a role in switching metaawareness on or off, but in ADHD, this switch appears to be faulty. This faulty mechanism seems to respond well to mindfulness meditation for example. Fox & Christoff (2014), highlight a positive role for mindfulness meditation in SMW and metacognition, because it is about learning to pay attention on an immediate experience and developing an attitude of acceptance towards this experience. In one study of mindfulness, Brewer et al, (2011) used fMRI to investigate DMN activity in experienced meditators versus naïve controls (non-meditators), as both groups practiced mindfulness exercises. These researchers found that the DMN was deactivated in the experience meditators, and functional connectivity was stronger in DMN regions associated with selfmonitoring and cognitive control, before and during the meditation. In other words, these researchers found that SMW had decreased. In another study, Smalley et al, (2009) found that people with ADHD reported less mindfulness than non-ADHD controls, but more noveltyseeking, less self-directedness and more selftranscendence. Mindfulness may be negatively associated with ADHD, but it is positively associated with self-directedness and selftranscendence. This means that mindfulness could improve symptoms of ADHD as well as

self-directedness. Mitchell et al, (2017) assessed the feasibility, acceptability, and efficacy of a 8-week group based mindfulness intervention for ADHD, executive functioning (EF), and emotion dysregulation, in 11 adults with ADHD. Even though this was a small sample of people, the findings of this study were positive: ADHD, EF symptoms and emotional dysregulation improved. These findings suggested that mindfulness meditation could increase metaawareness in adults with ADHD. So, while it’s easy to assume that SMW is bad and attention is good, or that DMW is better than SMW, because you have control over the former and the latter feels like you’ve lost control, this essay shows that it’s difficult to draw conclusions from such simple assumptions. At this SGDP event, art practice traversed psychiatry in ways that illuminated polarised views. It is also difficult to draw firm conclusions from the medical versus social model, normality versus abnormality, imagination versus disorder. Automatism blurs the boundaries even further: science versus spiritism, madness versus creativity, psychical liberation versus therapeutics. Maybe the only conclusion that can be drawn is that mind wandering (a special kind of art), is a prototypical trait in ADHD (a certain type of disorder), but it could also be an indicator of a highly efficient brain that has more capacity to think, be curious and be creative. Daydreaming, fantasy, imagination as aspects of mind wandering are important elements of a healthy, satisfying mental life. But if any of these elements start to impair social functioning or prevent an individual from achieving their full potential, then maybe it would be best to consider appropriate ways to intervene. This SGDP event alluded to such notions, especially in relation to ADHD. It did not however, provide an answer to the question, is mind wandering: a best friend or worst enemy? Perhaps the right answer is yes, no, yes and no.

ADDISS has moved! Three days before Christmas last year ADDISS was given nine days to move out of its current premises. The ADDISS Trustees and Andrea worked solidly, negotiating an extension to stay at the current site until the end of January and then contacting office locations around the area of Hendon to find a new home for ADDISS. In true ADHD fashion the team found a fantastic new premises Hendon which has a large training room and preferential rates for visitors at the Premier Inn hotel directly below allowing ADDISS to host more ADHD training events – watch this space. The unexpected rent hike has put the charity under intense pressure and there is a great need now to raise and secure additional funding.

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- Spring 2018